Employee Benefits Blog

Nearly 100 million workers, or two-thirds of the U.S. workforce, will be impacted by new vaccine requirements announced by President Biden yesterday. 

Prompted by a surge in COVID-19 infections, hospitalizations, and deaths - most especially among the unvaccinated - the requirement stipulates that employers with 100 or more employees require their workforces to be vaccinated or undergo weekly Covid-19 testing.

While it’s expected to be challenged in the courts, this new requirement is part of a six-point initiative the White House laid out yesterday to boost vaccinations, increase access to testing, and broaden the availability of Covid-19 treatments.

Final details of the plan will come by way of an "emergency temporary standard" issued in the next few weeks by the Labor Department’s Occupational Safety and Health Administration (OSHA). Businesses that don’t comply may face fines of up to $14,000 per violation. 

Per yesterday’s announcement, workers will be considered vaccinated if they receive a single Johnson & Johnson dose or two doses of the vaccines from Moderna or Pfizer. It’s unclear how a booster shot might play into things if/when approved by federal regulators.

Here are additional details of the plan.

Many employers are struggling to increase COVID-19 vaccination rates among their workforce, concerned not only about the safety of the workforce but also the costs of COVID-19 treatment that could be avoided through vaccination.

Some, like Delta Airlines, are turning to higher premium costs, or a surcharge, for any group health plan participants who remain unvaccinated. This decision by Delta, taken once an FDA-approved vaccine came on the market, should by no means be interpreted as a full-throated endorsement of this action. In fact, it’s quite likely that Delta’s decision will be tested in the courts.

Challenges are likely to come in three areas: wellness positioning, surcharge amounts, and possible discrimination. Nevertheless, Delta’s decision has prompted some employers to consider doing something similar.

Here are issues employers need to consider if they decide to take similar action.

As employee benefits consultants, we take our responsibility seriously to educate employers and employees on resources available to help reduce employee benefits program costs and out-of-pocket healthcare expenses.

This is especially true for those enrolled in High Deductible Health Plans (HDHPs), but even for those who aren’t. For without any effort, as a collective, to become more price-conscious consumers, healthcare providers will have no reason to reign things in.

In a recent blog, we discussed how consumers can save on prescription medications, including comparison shopping, manufacturer rebates and discounts, drug substitution, pill splitting, bulk buying, mail-order, and more.

As a complement to that blog post, today we’ll discuss various ways consumers can save on healthcare services and procedures. After all, when combined, hospitals and physician/clinical services account for 48% of healthcare expenses.

With nearly half of medical expenses centered around these areas, it makes sense for healthcare consumers to focus on these cost centers as target-rich environments for possible savings.

With over half of today's workforce enrolled in high-deductible health plans (51%), a majority of insured individuals are now on the hook for deductibles of at least $1,400. In addition, those with family coverage are responsible for at least $2,800.

While these higher deductibles are offset by cheaper monthly medical premiums and often by employer contributions to Health Savings Accounts (HSA), HDHP plans are nevertheless structured in such a way as to promote heightened "healthcare consumerism."

Judging by the sticker shock most consumers experience the first time they pay for medical services or prescription drugs without a copay, this heightened awareness of the "true cost of care" seems to be making an impact. As a result, consumers are indeed becoming more proactive about shopping for services and comparing prices, just as they would for any other consumer good.

Many employers, especially those that are self-funded, encourage this type of behavior since it can help them control costs and ultimately save significant dollars for both the company and its employees. (Employers with fully funded medical plans also have plenty of reasons to control their medical claims, though the potential savings often aren't recognized as immediately.)

And while consumers seem to have a love/hate relationship with HDHPs, many of those who take the time to fully calculate the total out-of-pocket cost of medical coverage and care realize that HDHPs, even with higher deductibles, can often save them money.

This isn't to say that HDHPs are for everyone, and if a company isn't helping its workforce adequately prepare for this change in consumer behavior, they are setting themselves up for failure.

Since we wouldn't want that to happen, here are eight suggestions to offer your workforce to help them save money on prescription drugs. In a future post, we'll offer tips on how to save money on common medical procedures.

Please share this information with your workforce. In doing so, you'll be helping them to become better consumers of healthcare and more satisfied enrollees in high deductible health plans.

Anyone who has ever signed up for cellular phone service with a mobile phone carrier knows what a burdensome service agreement looks like. It's pages and pages of terms and conditions, often delivered by an anxious salesperson consumed with an expectation that the customer desiring service will sign the carrier agreement on the spot.

While consumer law often provides protections to the little guy when big corporations require the signing of contacts like this, the courts aren't nearly as understanding when it comes to agreements between business parties. In many of these cases, the courts expect business-to-business agreements to be fully enforced.

This is particularly unfortunate given what's occurred over the last decade in the employer-sponsored group benefits space. These agreements have morphed from straightforward, comprehendible documents to verbose and cryptic agreements that shift virtually all risk to the plan sponsor (e.g., the employer) while relieving the vendor from almost all meaningful liability.

Plan sponsors have seen some of this behavior abate in recent years, fueled by their successful push back against commercially unreasonable contract provisions. Furthermore, the DOL's Fiduciary Rule, which went into effect July 1, 2019, has also helped neutralize some of these more unreasonable provisions.

Nevertheless, employers should resist the temptation to view the provisions of their employee benefits vendor contracts as minor details. The wrong provisions could easily bankrupt a small to medium-size business or cripple the growth of a larger one.

Although every single word of every vendor contract needs to be reviewed carefully by not only you and your employee benefits broker, but also qualified legal counsel, here is a list of five common provisions that require special attention.

By 2025, almost 23% of the U.S. workforce is expected to work fully remote, according to Upwork. That’s nearly double the percentage of people who were working remotely (full time) prior to the pandemic. 

While this prediction might be lower than some employers are expecting, (and some employees may be hoping for), any shift of this magnitude, or greater, will fundamentally change the way employers attract and retain talent.

With remote work quickly becoming one of the most desirable benefits an employer can offer in today’s tight labor market, employers are already discovering that they are competing for top candidates not only locally, but globally. 

For some highly desirable employers, this can be seen as a huge boon to their recruiting efforts. For other employers, especially those in less desirable industries, or those with poor reputations and/or employee benefit plans, this should be viewed as a tremendous concern.

Here are some unique qualities of strong remote workers and best practices for attracting and recruiting them. 

The COVID-19 pandemic is finally getting under control. As more Americans get vaccinated, states are gradually lifting restrictions, and life is returning to pre-pandemic normalcy. Finally, individuals can get to the tasks they’ve been postponing for more than a year.

Unfortunately for employers looking to retain employees, some employees are now ready to find new jobs.

Turnover is a common occurrence throughout any given year. However, during the COVID-19 pandemic, year-over-year turnover trends drastically reduced. Workers instead clung to their jobs as a way to maintain financial security, having seen countless others get furloughed or laid off.

Now, as the economy opens back up, employers are pushing for employees to return to the workplace. But, a significant number of employees are unwilling to return to the status quo that was established pre-pandemic.

Before working in employee benefits, I spent nearly a decade working for America Online (AOL). For those of you not old enough to remember, AOL was the gateway to the internet for tens of millions of people in the mid 1990's and early 2000's, as the "world wide web" went mainstream.

In those days, AOL's senior leadership placed bets on all sorts of industries they thought they could disrupt, from online dating and car shopping to airline bookings and online auctions. When asked what the company was learning from placing strategic bets in all of these commerce verticals, AOL's Founder Steve Case said, "it appears that anything that's easier to do online than offline will eventually transition to the web."

That very same insight can now safely be said of telemedicine. While both patients and providers were slow to embrace it, the popularity of telemedicine exploded this past year, while funding for almost anything telehealth-related has been booming.

According to technology vendor AthenHealth, they saw telehealth volumes in their network increase from less than 1% of total volumes pre-pandemic to as high as 32% during the pandemic, before settling in at around 10-11%.

And while it may be tempting to brush off telemedicine as a stopgap measure that served its purpose during this unprecedented healthcare emergency, new research shows that virtual care will long outlast the pandemic itself. In fact, experts predict that the telehealth market is expected to reach $185.6 billion by 2026.

Why? Because simply put, it's easier to do online than it is to do offline.

In a recent study by Doctor.com, telemedicine was shown to save patients over 100 minutes of their time compared to in-person office visits. Add to this that video visits often trigger a lower co-pay than an in-person appointment, and you have a winning combination – a savings of both time and money.

Employers bracing for a post-pandemic baby boom can rest easy. A spike in post-pandemic pre- and postnatal healthcare costs, as well as an influx of maternity and paternity leaves, aren’t likely to come to fruition. 

While nationwide data on birth numbers isn’t expected to come until later this year, an Associated Press analysis of data from 25 states indicates that the anticipated baby boom looks more like a bust. Recently released data by the CDC and the U.S. Census Bureau also supports much of the same. 

The data indicates that births have fallen dramatically in many states during the coronavirus outbreak. Births for all of 2020 were down 4.3% from 2019. Still, more tellingly, births in December 2020 and in January and February 2021 (nine months or more after the spring 2020 lockdowns) were down 6.5%, 9.3%, and 10%, respectively, when compared with the same periods a year earlier.

Together these declines account for an 8% decline versus a year ago, making this period the lowest the birthrate has dropped in over 40 years. This is good news for employers since childbirth and newborn care are oftentimes the most expensive medical conditions billed to employer-based insurers.

That said, falling birthrates present a host of other challenges that dwarf high claims costs.  

Visit most any restaurant these days and you’ll quickly interact with one of the “winners” of this pandemic. I’m talking about QR codes. These “bar codes on steroids”, now used to launch menus and online ordering apps, made a roaring comeback in 2020 thanks to their usefulness in the socially-distanced era of COVID-19.

That same can be said for telemedicine. While telemedicine has been around for decades, it’s acceptance by both patient and provider was somewhat anemic, at best, until the pandemic hit. Before COVID-19, it wasn’t at all uncommon to see telemedicine utilization rates in the single digits. Now it’s not unusual to see utilization rates in the 60 to 70 percent range.

While it’s wonderful to see a more widespread acceptance of this highly convenient and efficient healthcare delivery method, there is immense confusion over the set of terms used somewhat haphazardly (and interchangeably) to describe these virtual health services.

In the past year, we’ve heard carriers, employers, patients, policy makers, payers, and providers use everything from “telemedicine”, “telehealth”, and “telecare”, to “virtual medicine”, “virtual health” and “virtual care” to describe health services delivered via telecommunication technologies.

This post attempts to shed some light on the difference between these terms. While the differences might not seem all that important, they can be when working across different organizations, especially where reimbursement, data exchange, and data protection is concerned.